Antidepressants for hot flashes

Examples

Generic Name	Brand Name
fluoxetine	Prozac
paroxetine	Paxil, Paxil CR
venlafaxine	Effexor

Certain antidepressants are approved by the Health Canada's Therapeutic Products Directorate (TPD) for treating depression, bulimia, panic disorder, obsessive-compulsive disorder, and severe premenstrual syndrome (PMS), known as premenstrual dysphoric disorder (PMDD).

Fluoxetine and paroxetine are a type of antidepressant called SSRIs (selective serotonin reuptake inhibitors). SSRIs are not approved for hot flashes, but some have been shown to be effective in randomized trials. This is also the case for venlafaxine, a similar type of antidepressant called an atypical antidepressant.¹ Some antidepressants are also prescribed for the treatment of such conditions as chronic pain, fibromyalgia, and PMS; these are unlabelled uses.

How It Works

Selective serotonin reuptake inhibitors (SSRIs) affect the brain's use of a neurotransmitter chemical called serotonin, which is thought to have a role in regulating body heat.² Increased serotonin use by the brain can also improve perimenopausal mood swings and irritability.

Venlafaxine affects the brain's serotonin and norepinephrine levels. How it affects hot flashes is not known. Mood may also improve with venlafaxine use.

Why It Is Used

Select antidepressants are used to treat hot flashes affecting menopausal women.² They may also help with irritability, depression, and moodiness. They can be used before and after menopause as a symptom treatment alternative to hormones (birth control pills or hormone replacement therapy [HRT]).

Antidepressant therapy helps many men and women with hot flashes from cancer treatment.

Do not take venlafaxine if you:

• Have had an allergic reaction to this medication in the past.
• Are currently taking an MAOI (monoamine oxidase inhibitor). This is an antidepressant and anti-anxiety medicine. Examples include phenelzine sulfate (Nardil) and tranylcypromine sulfate (Parnate).

How Well It Works

Studies have shown that these antidepressants help relieve hot flashes in the majority of women treated.¹

• In a randomized, controlled trial of paroxetine (Paxil) for post-menopausal women having at least 14 bothersome hot flashes per week, researchers report that about 60% of women had at least a 50% reduction in the severity and number of hot flashes per day after 6 weeks of treatment.²
• Venlafaxine (Effexor) lowers the number and severity of hot flashes for most women. This includes women with severe hot flashes from tamoxifen, a cancer-fighting hormone drug. In several studies, venlafaxine was most effective for hot flashes when used at a lower dose than is normal for treating depression.³

Side Effects

Possible SSRI side effects include:

• Headache.
• Nausea.
• Insomnia.
• Loss of appetite.
• Anxiety or nervousness.
• Drowsiness.
• Nightmares.
• Diarrhea.
• Loss of ability to reach orgasm during sexual activity.
• Dizziness or light-headedness.
• High blood pressure.

Rare SSRI side effects include:

• Dry mouth.
• Constipation.
• Urination problems.

Time-released formulations and lower doses reduce the risk of side effects.²

Possible venlafaxine (Effexor) side effects are similar to those of SSRIs. Venlafaxine can also cause:

• Constipation.
• Weight loss.
• Dry mouth.
• A slight increase in cholesterol.

Other more serious side effects are rare but can include allergic reaction, fast heart rate, nausea, dizziness, anxiety, blurred vision, insomnia, increased blood pressure, and seizures. Because venlafaxine (Effexor) can increase blood pressure, it is used with caution in women with high blood pressure, heart failure, or glaucoma.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

Advisories. Health Canada and the U.S. Food and Drug Administration (FDA) have issued:

• Advisories on antidepressant medicines and the risk of suicide. Health Canada and the FDA do not recommend that people stop using these medicines. Instead, a person taking antidepressants should be watched for warning signs of suicide. This is especially important at the beginning of treatment or when doses are changed.
• Warnings about the antidepressants Paxil and Paxil CR and birth defects. Taking these medicines in the first 12 weeks of pregnancy may increase your chance of having a baby with a birth defect.

What To Think About

This is considered an off-label use for SSRI antidepressants.

The side effects most commonly reported with paroxetine (Paxil) use for hot flashes were headache, nausea, and insomnia. About 58% of women reported side effects. (Interestingly, of women who were taking a placebo, about 53% also reported side effects. Similarly, about 43% of women taking a placebo reported a 50% or better improvement in hot flashes.)²

Ongoing research is needed to determine the risks and benefits of long-term SSRI treatment. However, many people have used these medications for long-term treatment of depression.

Never stop taking antidepressants abruptly. The use of any antidepressant should be tapered off slowly and only under the supervision of a health professional. Abruptly stopping SSRI medications can cause headaches, nervousness, anxiety, or insomnia.

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Author:	Kathe Gallagher, MSW Carrie Henley	Last Updated: August 4, 2006
Medical Review:	Joy Melnikow, MD, MPH - Family Medicine Tom Bailey, MD - Family Medicine Carla J. Herman, MD, MPH - Internal Medicine
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